Background
Retrospective single-institution analysis (UCSF). Parotid gland carcinoma with clinically node-negative (cN0) necks, treated with surgery and post-operative RT. Evaluated whether elective neck irradiation (ENI) improved regional outcomes vs observation in the cN0 setting.
Interventions and follow up
Treatment: surgery + post-operative RT, with vs without elective neck irradiation (ENI) of the cN0 neck
Primary endpoint: regional recurrence rate in cN0 neck
mFollow up: NR
Primary endpoint: regional recurrence rate in cN0 neck
mFollow up: NR
Results
Regional recurrence (cN0 neck): NR (quantitative rates not detailed in source)
Elective neck irradiation: reduced regional failure in high-risk histologic subtypes and stages
Elective neck irradiation: reduced regional failure in high-risk histologic subtypes and stages
Adverse events
Toxicity grading: not formally graded (retrospective data)
Treatment-related mortality: NR
Treatment-related mortality: NR
Conclusions
Elective neck irradiation should be considered for high-risk cN0 parotid carcinoma, particularly high-grade histology, advanced T-stage, perineural invasion, or lymphovascular invasion.
Key Limitations
Single-institution retrospective, non-randomized with selection bias; relatively small cohort; pre-IMRT era neck delineation; quantitative recurrence rates not detailed in available summary (refer to original publication).
Clinical Context
Management of the cN0 neck in parotid carcinoma remains debated. Practice favors ENI for high-grade tumors (high-grade mucoepidermoid, salivary duct carcinoma, carcinoma ex pleomorphic adenoma, undifferentiated) and T3–T4 disease or adverse pathologic features; low-grade histologies (acinic cell, low-grade mucoepidermoid) may be observed.